Introduction Despite documented low risk (<1%) of stomal metastases and limited evidence-base, current BSG guidelines advocate a direct puncture approach to gastrostomy in head & neck cancers (HNC).1 We hypothesised that there would be a variation in the gastrostomy insertion practices for HNC and surveyed hospitals in our region and aimed to retrospectively determine the incidence of PEG site metastases at our centre where pull-through technique PEG is often the first line approach in HNC.
Methods Firstly, an electronic survey on gastrostomy insertion practices in HNC was circulated to all members of the regional Gastroenterology network (representing 11 NHS hospital trusts in the North West of England). Secondly, in a retrospective study, all PEG placements using pull-through technique for HNC at Lancashire Teaching Hospitals between 2011–2014 were reviewed. Data including patient demographics, tumour site, size, stage and histology, HNC treatments before and after PEG, PEG insertion details, length of follow-up, imaging of the PEG site post procedure and sites of recurrence, were recorded. Data are expressed as the mean (± standard error of the mean) unless stated otherwise.
Results The survey of endoscopists (n = 30, 11 consultants) from ten NHS trusts in the North West revealed that seven centres were compliant with BSG guidance (six using radiologically inserted gastrostomy techniques and one offering endoscopic gastropexy as first-line). Three centres use the pull-through technique for HNC. Only 2/30 (7%) of respondents (both consultants) have ever encountered a case of PEG site metastases in their careers post pull-through PEG insertion for HNC. In the retrospective study, 106 HNC patients (age 60 ± 1 years, 77 male, 29 female) were followed-up for 784 ± 40 days post pull-through PEG insertion. Most patients had tumours within the oral cavity (70%), 22% had tumours in the pharynx or below, with the remainder having neck lesions. Overall, in 92% of cases PEG placements were prophylactic (pre-treatment), 49% had documented peg removal at a mean time of 499 ± 45 days, 29% developed recurrent/ metastatic disease and 25% died at 488 ±54 days post PEG insertion. There were no cases of PEG site metastases identified, however only 36% had imaging of the PEG site post-procedure with most recent imaging available at 682 ± 102 days post-procedure.
Conclusion Our survey highlights a variation in gastrostomy practices for HNC across the region. Despite the BSG guidelines, some centres still use the pull-through approach and our data suggest the risk of seeding with this approach is low.
Reference 1 Westaby D, et al. Gut 2010;59(12):1592–605.
Disclosure of Interest None Declared